Maria Lengquist1,2, Oscar H M Lundberg1,2, Martin Spångfors1,3, Martin Annborn1,4, Helena Levin1, Hans Friberg1,2, Attila Frigyesi1,2. 1. Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden. 2. Skåne University Hospital, Intensive and Perioperative Care, Lund, Sweden. 3. Department of Anaesthesia and Intensive Care, Kristianstad Hospital, Kristianstad, Sweden. 4. Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
Abstract
BACKGROUND: Sepsis is a common indication for admission to the intensive care unit (ICU). Since definitions vary across studies, comparisons of prevalence and outcomes have been challenging. We aimed to compare sepsis according to ICU discharge codes with sepsis according to Sepsis-3 criteria and to investigate the epidemiology of sepsis in the ICU. We hypothesized that sepsis using discharge codes is underreported. METHODS: Adult ICU admissions to four ICUs in Sweden between 2015 and 2017 were screened for sepsis according to the Sepsis-3 criteria. Medical records were reviewed and data extracted from the Swedish Intensive Care Registry. RESULTS: Of 5990 adult ICU patients, 28% fulfilled the Sepsis-3 criteria on admission, but only 31% of them had sepsis as the registered main diagnosis at ICU discharge. Of the 1654 Sepsis-3 patients, 38% met the septic shock criteria. The Sepsis-3 in-hospital mortality was 26% compared to 33% in patients with septic shock. The incidence rate for ICU-treated sepsis was 81 cases per 100 000 person-years. One in four had a positive blood culture, and 44% were culture negative. CONCLUSION: This large Swedish multicentre study showed that 28% of adult ICU patients fulfilled the Sepsis-3 criteria, but only one third of them had sepsis according to ICU discharge codes. We could confirm our hypothesis, that sepsis is severely underreported in Swedish ICUs, and we conclude that discharge codes should not be used for quality control or research purposes.
BACKGROUND:Sepsis is a common indication for admission to the intensive care unit (ICU). Since definitions vary across studies, comparisons of prevalence and outcomes have been challenging. We aimed to compare sepsis according to ICU discharge codes with sepsis according to Sepsis-3 criteria and to investigate the epidemiology of sepsis in the ICU. We hypothesized that sepsis using discharge codes is underreported. METHODS: Adult ICU admissions to four ICUs in Sweden between 2015 and 2017 were screened for sepsis according to the Sepsis-3 criteria. Medical records were reviewed and data extracted from the Swedish Intensive Care Registry. RESULTS: Of 5990 adult ICU patients, 28% fulfilled the Sepsis-3 criteria on admission, but only 31% of them had sepsis as the registered main diagnosis at ICU discharge. Of the 1654 Sepsis-3 patients, 38% met the septic shock criteria. The Sepsis-3 in-hospital mortality was 26% compared to 33% in patients with septic shock. The incidence rate for ICU-treated sepsis was 81 cases per 100 000 person-years. One in four had a positive blood culture, and 44% were culture negative. CONCLUSION: This large Swedish multicentre study showed that 28% of adult ICU patients fulfilled the Sepsis-3 criteria, but only one third of them had sepsis according to ICU discharge codes. We could confirm our hypothesis, that sepsis is severely underreported in Swedish ICUs, and we conclude that discharge codes should not be used for quality control or research purposes.
Authors: Attila Frigyesi; Lisa Boström; Maria Lengquist; Patrik Johnsson; Oscar H M Lundberg; Martin Spångfors; Martin Annborn; Tobias Cronberg; Niklas Nielsen; Helena Levin; Hans Friberg Journal: Intensive Care Med Exp Date: 2021-07-19
Authors: Oscar H M Lundberg; Maria Lengquist; Martin Spångfors; Martin Annborn; Deborah Bergmann; Janin Schulte; Helena Levin; Olle Melander; Attila Frigyesi; Hans Friberg Journal: Crit Care Date: 2020-11-04 Impact factor: 9.097